Each year in the United States alone, 1.7 million patients contract a nosocomial, or hospital-acquired infection (HAI). Ninety-nine thousand people die annually as a result of these infections, making this the fourth leading cause of death in the United States. The direct medical impact of HAIs on the healthcare system is estimated at $35-$45 billion. It is estimated that the combined direct and indirect costs; i.e. impact on humanity, is $96-$147 billion.
An HAI is an infection acquired in hospital by a patient who was admitted for a reason other than that infection. There are numerous varieties of pathogens that can result in HAIs, some of which are antibiotic resistant. The most commonly reported pathogen (as high as 30%) is Clostridium difficile (C. diff.), which is also one of the most difficult to remediate. Other pathogens can include Acinetobacter, MRSA, VRE, and Norovirus, for example.
HAIs and their treatment are a complicated problem, and for many years have been considered an unavoidable risk and expense. Additionally, the federal Centers for Medicare Services has deemed that certain infections are avoidable, and the care associated with them ineligible for reimbursement. Private payers are following Medicare's lead and beginning to deny payments for HAIs. This trend will certainly continue. Since the Affordable Care Act was enacted in 2010, there have been several changes to the policies regarding reimbursement of HAI costs. The financial burden associated with HAIs is being shifted to healthcare institutions. Beginning in 2015, the 25% of hospitals with the highest rates of HAIs will face penalties of one percent of their Medicare payments.
An additional burden incurred by hospitals as a result of HAIs is an increased length of stay (LOS). Reimbursements from payers to hospitals are treatment-based and independent of the length of stay, so there is a clear benefit to keeping LOS to a minimum. For a patient contracting an HAI, LOS increases from an average of 3.6 days to 22.2 days, with the hospital absorbing the additional costs.
More than ever, the pervasive HAI problem within the healthcare system affects the reputations of hospitals and healthcare providers. The Affordable Care Act of 2010 has established new reporting mechanisms that create online resources where the public can compare the incidence of HAIs at their local hospitals. Clinical care outcomes will become visible to patients, allowing them to become more selective about their care providers in ways that will have a significant effect on a hospital's overall patient volume and bottom line.